How NOT to sell me a cosmetic procedure.....

I am generally dissatisfied with my skin.  I've been pondering microdermabrasion vs peels etc for a long time but never went further than buying Roc's home microdermabrasion kit with the vibrating/spinning applicator

I pretty randomly chose Skin Vitality as somewhere to try, they happened to be featured in a Groupon offering cheap Botox.  I pushed aside my other knowledge of them-their appearance in the Global News 16:9 Botox exposé (episode is Worry Lines).  In that episode they were one of the clinics where medical supervision was via Skype.  The doctor who injected my Botox (Dr Torgerson) was featured as someone who does it himself!

Anyway, I emailed and asked about prices of peels.  The reply said they started at $85 and offered a free consultation.  Why not?  I booked a midday appointment today and trotted in.

I was met by a "medical consultant".  Very friendly.  Briefly heard that I wanted to know about peels but then told me my concerns of uneven skin and fine lines around my eyes etc would be much better treated with skin tightening.  Their machine is an Elos machine which uses IPL (intense pulsed light) and radiofrequency waves apparently.   I suppose IPL is usually a big selling point but I'm a bit biased.  Wasted a pile of money on almost completely unsuccessful hair removal with IPL a few years ago.  I was bombarded with information about the technology, the features on Oprah, how it would fix my sagging skin/lines/under eye circles.  I would look 10 years younger after it.  She stated that since I'm 33, I'd look 23.  She showed me a quick PowerPoint presentation.  Interestingly, the before and after images weren't actually that dramatic.  You'd think they'd use their best cases for a presentation so it doesn't really give the impression of being fantastic.
The presentation was followed by her taking out the calculator and telling me about the promo they had. I zoned out for most of her calculations after I realised she was basing them on 6 treatments and the reduced price cost was around $2400!!

I said I wanted to think about it so she offered me a free trial of it to see what the treatment was like and meet the nurse.  She got me a slot an hour later.  I went for lunch and came back.  I was on time, they were around 25 minutes late.  The nurse, to be fair, was fantastic.  The first thing she said was "you don't need this!".  She thought peels or Fotofacial would be more appropriate.  She reckoned Fotofacial would be better for evening out colouration and tone.  She said the tightening was usually for people in their 40s and 50s but that I looked OK for 33!

She kindly did the treatment anyway just to see what it was like.  The mini test is around the eyes.  I was given protective goggles and the area was covered in gel.  She ran the handpiece over the lateral (outside) borders of my eyes.  I could see a tiny flash of light with every pulse and felt some heat each time but it wasn't painful.  Apparently full face takes approximately 40 minutes.

I had to meet another consultant then who gave me more quotes-special offer, today only etc etc.  Again, I said I wanted to think about it all.  She was very nice about it all though.  Gave me her card and said she'd be there until 8pm.

So, here are the eyes that apparently look like someone in their 40s or 50s:

I'll agree that the areas under my eyes are puffy but I think lack of sleep contributes.  I also think a bit of Restylane in my tear troughs might help more.  There are tiny lines, but I hadn't been overly concerned by the ones at the edge of my eye and I'm wary of what I'd do with the ones on my lower lid.  Danger zone!

I did a quick search on RealSelf and it comes up as ReFirme.  Opinions are mixed and certainly not worth coughing up $2500 when money is tight!

What really stopped me though?

The sales pitch.  I barely got to talk about my concerns before I was told I was basically in terrible shape and in need of major anti-aging work.   I was bombarded with information about something I hadn't even considered and felt pressurised into agreeing.  I was given the "this offer is only for today" pitch which I despise.  I've had it in gyms before and have always scurried to the door.   She promised something that she actually could never back up and that wasn't going to happen-that I would look 10 years younger.  Doubtless the estimation of my age would be based on her impressions!  I liked the nurse immensely and if I had spent most of my time with her and not felt like I had to sign up for a series of treatments, I might have considered it.  The way it was though?  No way.

In contrast, Dr Torgerson did suggest something I hadn't thought about the day I went in for my Botox injection (initial treatment).  He suggested filler in my tear troughs.  It was done completely differently though.  It was a "something you might like to think about" and he said (lied) that he was just being picky and mean.  There was no way I felt under pressure to decide that day.  At all.  I got to go home and Google etc.  (This description by Dr Ravi Jain is my favourite) I still don't have the money for it right now, but if I had I'd probably do it.  Because it's my decision and I'd feel like I had made it with all the best information and without being rushed...

Heidi Montag claims plastic surgery botched

Strangely enough, I was thinking about Heidi Montag today.  I had been pondering the prospect of fillers in my face and how important it is to do it properly.  She often comes to mind as someone who I thought looked much prettier before she had plastic surgery.  Her breasts look ridiculous but her face bothers me more.  She was an attractive girl before, but after the surgery just ended up with a bland look-the same as all the other cookie cutter Hollywood Hills types.

There's nothing too much that's wrong in isolation.  Her nose is a good nose.  Her chin is a good chin.  Her lips are a bit big, but not terrible.  It's the face as a whole that doesn't really work for me.  She looks plastic.

Anyway, the latest is that she's gone to the magazines saying that she has awful scars from surgery and that she wasn't fully informed of all the risks before the procedures.

There's more here on the Daily Mail website.

While I feel a little sorry for her, it's hard to know who is mostly to blame here.  She says surgeons act as if they're giving out cookies.  Maybe some are a little over confident and minimise risks...but I think that is true of many (if not most) surgeons-not just cosmetic surgeons.  A certain amount of ego helps to get ahead and, more importantly, a degree of confidence is necessary to undertake any procedures.  Would you really want to have someone who is terrified and shaking to be close to you with a scalpel?  If every surgeon went through every single potential complication that possibly could happen (remember, it always includes death) and gave each the same emphasis, then nobody would every have an operation.

One of her biggest complaints seems to be bad scars.  I can only see the scar under her chin in those photos.  It's not a great one, to be fair.  However, there's sometimes only so much the surgeon can do.  They can do their best to do neat sutures but individual factors come into play.  Some people have skin that develops keloid scars or a less severe type-hypertrophic scars.  Wound infections or traction forces (e.g. from swelling or movement) can lead to poor healing with wider or irregular scars.  It's a risk of any procedure.

I'm not sure what was said to her during her consent.  I have absolutely no idea what she believed going into it, but as patients we can't really claim ignorance any longer.  NO procedure is without at least some risk.  Yes, the person doing it should tell us what to expect but we have an obligation too.  We need to do the research and make sure that the potential benefits outweigh the risks.

There's no such thing as a free lunch; and there's no procedure without risk.

Latisse-yes or no?

I've been pondering the Latisse for the past few days in particular.  I do genuinely believe my lashes are a little longer.  If I use a curling mascara they definitely are more prominent.
What bothers me still is the idea of putting something known to cause iris pigmentation-albeit through a different route of administration-onto my lash line just to have longer lashes.  Fine, there were no reported cases in the trials and there are apparently no reported cases since it was approved.  But is this definitely true?  Searching around online yields people who say they've suffered the pigmentation.  Perhaps they're lying, but there are a few unsettling things:

• Latisse only launched in the US in 2009.  That means less than 2 years of follow-up of the product being used by large numbers of people
• Allergan reckon that Latisse supplies 1/20th of the dose of Lumigan when applied as directed.  Does this mean they expect a dose to the eye itself?
• Allergan have already been cautioned by the FDA for minimising the risks associated with the product in their promotional material.
• Eyes at highest risk for pigmentation seem to be those that already have some brown pigment-hazel and green.  Like mine.

When I was at the plastic surgeons office and he was telling me about it and recommending it to me I asked about the iris pigmentation.  He said there was no chance of it.  I think most prescribers would agree.  He told me his assistant who had blue eyes hadn't suffered any problems.  However:

• The assistant had used the product for less than 2 months.  The problems with Lumigan seemed to be at the 6-12 month mark
• She had blue eyes.  With no brown pigment.  She was therefore at a lower risk anyway.
• Allergan recommends that patients are informed of the potential risk for iris pigmentation, likely permanent....they had to because we know that Lumigan can cause it.  So it can't be ruled out.

I think the risk with Latisse is probably tiny.   I do think it raises the issue of how easily we dismiss risks just to look better!  I was happy to get carried away thinking about the longer, thicker lashes and ignore the reality of applying a medicinal product.  I like my eyes.  They're the one thing I wouldn't change.  I'm not sure what I'll do!  Reviews on RealSelf and Makeupalley are mainly very positive.  The results I get will help me to decide.  I could imagine wanting to continue if the results were striking.  At the moment I'm considering finishing this bottle and then just switch to Rapid Lash or the Dermaglow lash enhance.  They may not work but they're unlikely to destroy my eyes.  There's always mascara....

The Big Botox day

My appointment with Dr Torgerson eventually arrived.  I was terrified.  I'm not usually a bad patient but this really did worry me.  I was volunteering for a medical procedure based purely on vanity.  No medical need whatsoever.  It wasn't going to make me healthier, just a bit less grumpy looking.  And for that I was risking a frozen face and droopy eyes.  Was I crazy?  What would my mother say if she knew?  And why was I spending so much on myself when I should be saving to go home and visit my family?!?

Despite the major butterflies (seriously-they were more like huge flapping bats) in my stomach, I arrived at Dr Torgerson's office.  My nerves pretty much vanished when I met his office staff-Helen and Breanne.   They are so nice and so warm.  It was impossible to stay worried!  Helen is also Irish which was a bonus.  I was given a lengthy medical questionnaire and a cup of coffee and settled down to my form filling.

Dr Torgerson was maybe half an hour late seeing me but the time passed quickly and he was obviously with someone else-not just messing around on Facebook or something!  Helen took my "before" headshots and I waited in a big dentist-like chair in the treatment room.

When Dr Torgerson came in, any lingering fears vanished.  He is immensely likeable and spent the first few minutes just chatting about my work, the move to Toronto and so on.  We then discussed the Botox and he commented that glabellar lines are perfect for it (I think they were the initial cosmetic indication too).  He explained the physiology of action, the duration, what I'd expect during and after the procedure and potential complications.   He likes to completely freeze the muscles involved in creating those lines (which he likes to call "concentration lines") unlike other parts of the face where he tries to retain more movement.  The usual dose he uses is 25 units.  He then said there was one more thing that I might benefit from at some point.  My heart sank.  I'd been dreading the critical eye of a plastic surgeon and the pronouncement that I needed a nose job, a jaw revision, new ears, Botox all over, new lips.  "In fact", I was sure he'd say, "we should just get a refund on this face and get you a new one altogether".  He didn't.  With apologies for being mean and picky, he said that I had "tear troughs"-a fold/hollow at the edge of the eye.  He reckoned it probably looked flatter and I looked more drawn when tired.  I had to agree.  He told me that filler (like Restylane) could be injected to plump it-giving a fresher appearance.  He by no means pushed the procedure-just said it was something to think about.  These photos made me think that he's probably right!  Still can't afford it though.

Anyway, I signed my consent form for the procedure and we got on with it.  His fancy chair can be tipped back and he told me that he uses a teeny tiny needle (32G!) for the injections.  I was given a squeezy Botox toy just in case.  The injections were really fine.  5 of them in total.  Some felt a bit funny-like a crunchy sensation by the inner brow-but perfectly tolerable.  It really is just a little pinch.  I held a little gauze to my head for a few minutes and then was ready to go.  He said it would take at least 3 days to show an effect and that top-ups were free if I didn't see enough of a change.   He also mentioned that they were getting Latisse the following week...which definitely sounded interesting too!

I chatted with Helen and headed out the door.

How did I feel?  Fine.  Can't say there was much of a sensation.  That part of my forehead felt a little fuller than usual and a bit heavy but didn't really bother me.  The tiny marks weren't even visible.  I went home, my Botox virginity lost forever...